ASK HIM: Hospital Admission Dates for ED Patient

Question from Dianna E.: I wanted to get an opinion on the documentation of admission and discharge dates on a discharge summary when the patient starts his/her stay in the ED, then to observation status, then to IP status. What should the actual admit date be: the ED date, the OBS date, or the IP date? Thank you.

Answer from OHIMA: Hospital admission begins with a physician's order to admit.  So if the patient is in the ED at 11:00 p.m. on the 29th and is not admitted until 3:15 a.m. the next day (the 30th), the admit date is the 30th.  The same would be true if there was an observation status in-between, the admit isn't until the admit order is written, signed, and dated. 

Now the part that muddies this is that Medicare has the "three-day window" where outpatient services related to the admission are included on the inpatient stay.  So the ED and observation charges will end up on that admit.

Information related to this can be found in the Medicare Claims Processing Manual and on the CMS website at: https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/Three_Day_Payment_Window

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